Pediatric anesthesia & critical care
Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU*
Authors' conclusion
Implementation of VL-assisted coaching achieved a high level of adherence across the PICUs. VL use was associated with reduced adverse TIAEs.
Study context
- Population
- Patients undergoing tracheal intubation in the PICU
- Participants
- 5,060 tracheal intubations
- Exposure
- Video laryngoscope (VL)-assisted coaching vs standard laryngoscope
- VLn = 3,580
- SLn = 1,480reference
- Outcome
- Adverse tracheal intubation associated events (TIAEs)
Methodological details10 PICUs in North America, VLs implemented 2016–2020; laryngoscopists encouraged to perform direct laryngoscopy, video images available in real time only to experienced supervising clinician-coaches
- 10 PICUs in North America
- VLs implemented 2016–2020; laryngoscopists encouraged to perform direct laryngoscopy, video images available in real time only to experienced supervising clinician-coaches
Main finding
As reported in the abstract
TIAEs
VL vs SLAbsolute difference (95% CI)P value
TIAEs
5.1%(3.1–7.2%)
P < 0.001VL vs SLEstimate (95% CI)P value
Primary analysis adjusted for site clustering
OR 0.61(0.46–0.81)
P = 0.001Further adjusted for patient and provider characteristics
aOR 0.65(0.49–0.86)
P = 0.003Observational data: associations, not effects.
Secondary outcomes
Severe TIAEs · unadjusted
P = 0.024
Severe hypoxemia (oxygen saturation < 80%) · unadjusted
P = 0.58
First attempt success · unadjusted
P < 0.001
| Outcome | Estimate | P value | |
|---|---|---|---|
| Severe TIAEsAdjusted for site clustering | OR for severe TIAEs 0.72 (95% CI 0.44–1.19) | P = 0.20 | |
| Severe hypoxemia (oxygen saturation < 80%)Adjusted for site clustering | OR for severe hypoxemia 0.95 (95% CI 0.73–1.25) | P = 0.734 | |
| First attempt successAdjusted for site clustering | OR for first attempt success 1.28 (95% CI 0.98–1.67) | P = 0.073 | |
| 0.512Ratio (log scale) |
VL use, baseline vs implementation phase
- VL use at baseline
- 29.7%
- VL use in implementation phase
- 89.4%
- p < 0.001
Original publication
Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU*. Crit Care Med. Published 27 March 2023. doi:10.
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